Cloward's anterior fusion in the treatment of cervical spinal traumatic injury and degeneration.

The aim of this study was to evaluate the long-term results of Cloward's anterior interbody fusion of the cervical spine and to identify the factors influencing them. The series consisted of 29 patients operated on in 1968--75. The indication for operation was in 12 cases intensive radicular symptoms, not responding to conservative treatment, in connection with considerable degeneration of the corresponding spinal segment only, and in 17 cases instability of the cervical spine caused by traumatic injury followed by dislocation and radicular or medullary symptoms enhancing in spite of conservative treatment by skull traction or collar. Twenty-five patients (86%) attended follow-up after an average time lapse of 6.5 years from operation. The operative result was evaluated considering objective neurological improvement, subjective improvement, present symptoms and working capacity. The operative result was at least fair in 7/11 in the degeneration group and in 12/14 in the traumatic injury group. All fusions were radiologically successful. Adequate correction of a primary flexion deformity of more than 15 degrees was not achieved. Age over 35 years and motor defect preoperatively proved to be statistically significant prognostic factors for a poor operative result in the traumatic injury group. Preoperative sick-leaves and a duration of preoperative symptoms exceeding six months proved to be prognostic factors for a poor result in the degeneration group. In spite of the relatively good clinical results obtained, this study does not justify any conclusions concerning the value of Cloward's procedure compared to other methods of treatment, since no control material was available.